WELCOMEThank you for the opportunity to assist you with the sale your property. In order for us to close your transaction quickly and efficiently, please complete all applicable blanks and checkboxes in the form below. Per Florida state law, all of the information provided will be kept strictly confidential. Should you have any questions or need assistance completing this form, please contact the processor on your file. Each person on your deed or with an interest in the property needs to be listed on this form. Attach additional pages if necessary. Please also send a clear copy of your driver license or passport along with your completed form.Property AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeABOUT THE SELLERSPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameMiddle NameLast NameGenderMaleFemaleMarital StatusMarriedSingleWidow(er)Social Security NumberAre you aUS CitizenPermanent ResidentOtherPhoneCell PhoneEmail AddressPost Closing AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweWill Seller #1 be present to sign your closing documents at our offices at the time of closing?YesNoIf Seller #1 will not be present, where will Seller #1 be for closing?PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameMiddle NameLast NameGenderMaleFemaleMarital StatusMarriedSingleWidow(er)Social Security NumberAre you aUS CitizenPermanent ResidentOtherPhoneCell PhoneEmail AddressPost Closing AddressApartment, suite, etcCityState/ProvinceZIP / Postal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaAustraliaArubaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCabo VerdeCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGuernseyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontserratMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSaint HelenaSaint Pierre & MiquelonSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUS Minor Outlying IslandsUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabweWill Seller #2 be present to sign your closing documents at our offices at the time of closing?YesNoIf Seller #2 will not be present, where will Seller #1 be for closing?ABOUT THE PROPERTYIs the property that you are selling held in a trust?YesNoIf yes, please provide a copy of the ENTIRE trust.Are any of the people on the deed deceased?YesNoIf yes, please provide us with the ORIGINAL death certificate.Is this property your homestead?YesNoIf no, please list your primary residence below:Currently or recently gone through a divorce?YesNoIf yes, what is the status?Have you recently filed for bankrupcty?YesNoAre you aware of any leins or judgements against you?YesNoIf yes, please list them:Are there mortgages on the property?YesNoFirst Mortgage HolderBank Name: Loan Number: Customer Service Phone Number:Please include a copy of your last mortgage statement with this form.Second Mortgage HolderBank Name: Loan Number: Customer Service Phone Number:May be a home equity loan, line of credit, or HELOC. Please include a copy of your last mortgage statement with this form.Do you pay dues to an HOA/Condo Association?YesNoMaster/Condo AssociationName: Phone: Fax:Neighborhood AssociationName: Phone: Fax:Country Club/Other AssociationName: Phone: Fax:Is this a short sale?YesNoDo you owe more than you are getting?Do you have a title insurance policy?YesNoPlease fax or email a copy of the policy IMMEDIATELY. If you contract is a NABOR contract, you have 10 days to provide this policy.Do you have a survey form when you purchased the property?YesNoHave you made any improvements to the EXTERIOR of your property?YesNoDo you have tenants that lease the property?YesNoIf yes, please forward a copy of the lease agreement as soon as possible.To whom do you make your water/sewer bill payment?DISCLOSURESAT CLOSING, YOU WILL DESIGNATE WHETHER YOU WANT A CHECK OR A WIRE FOR YOUR CLOSING PROCEEDS. PLEASE BE PREPARED WITH YOUR BANK WIRE ROUTING INFORMATION IF WANT YOUR PROCEEDS WIRED. THIS REQUIRES YOU TO CALL YOUR BANK AND CONFIRM THE WIRE ROUTING NUMBER AS IT WILL LIKELY BE DIFFERENT THAN THE INFORMATION ON YOUR CHECKS. I /we, the undersigned, hereby certify that all of the information provided on this Seller Information Form is true, correct and accurate to the best of our knowledge. I/we also acknowledge that providing false information in an attempt to commit fraud could subject us to state and federal criminal and civil penalties. Pursuant to Florida law, I/we agree to pay Paradise Coast Title’s standard fees and reimburse Paradise Coast Title & Escrow for any monetary advances made on my/our behalf for items, including but not limited to, estoppels, lien searches, application fees, etc. PLEASE BE ADVISED: Paradise Coast Title & Escrow, LLC does not provide legal advice. Unless otherwise expressly stated in writing, Sam J. Saad III does not represent the buyer or seller in your transaction. As settlement agent, our duties are to: (i) prepare the necessary legal documents that will consummate the transaction contemplated by the Purchase Agreement (the “Contract”); (ii) ensure that applicable settlement documents are properly executed; (iii) ensure that costs and expenses are allocated between the parties pursuant to the terms of the Contract; (iv) arrange for the payment and disbursement of closing proceeds and costs; (v) arrange for the recording of appropriate documents in the public records; and (vi) arrange for the issuance of the title insurance commitment and policy(ies). Please date and sign or type* your name below:Seller #1 SignatureStart signing your signature hereYour browser does not support e-Signature field.DateSeller #2 SignatureStart signing your signature hereYour browser does not support e-Signature field.DateNOTE*By typing your name above you agree to the following: By typing in your legal name, you are signing this form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form. By typing in your name you consent to be legally bound by this form's terms and conditions.Send Message